Biofeedback in musicians: A systematic review and meta-analysis of its effects on muscle activity, musculoskeletal health, and performance

Musicians are at high risk for playing-related musculoskeletal disorders (PRMD) and playing- or performance-related pain (PRP), which can severely interfere with their practice routine, rehearsals, and performance. Although biofeedback offers a promising approach to address these problems, it has not been widely implemented into music education or practice, underscoring the need for a comprehensive assessment of its efficacy for physiological, health, and performance outcomes. We conducted a pre-registered systematic search of 9 electronic databases, yielding 3041 published works, and included 49 studies on biofeedback in musicians that reported outcomes related to muscle activity, musculoskeletal health, or performance. After extracting relevant data, we performed a meta-analysis of 36 studies using Bayesian mixed-effects models to evaluate effects across time (pre- vs. post), condition (biofeedback vs. comparator conditions, including traditional practice), and type of outcome. Across the selected studies, we found compelling evidence that biofeedback improves muscle activity (primarily reflected as reductions in activation), performance, and musculoskeletal health, indicating its potential to address PRMD and PRP symptoms, while also targeting relevant risk factors and supporting overall performance quality. These findings suggest that biofeedback-driven body awareness and physiological regulation can form the foundation for effective and sustainable performance. Successful implementation, however, will require collaboration between scientists, educators, and musicians to integrate biofeedback into pedagogical practice, supporting both performance and physical wellbeing.